The Normal Periodontium III & IV Cementum & Alveolar Bone

Periodontology 1 DENT 371

Dr. Hisham Al-Shorman

Cementum

Thin layer of calcified tissue covers the roots of teeth, in which embedded collagen fibers attach the teeth to the alveolar bone

Development
Inner epithelial 1. root sheath Intermediate Cementum

Intermediate Cementum:

Acellular Very thin layer (10 nm)

Development
Periodontal 2. Ligament Fibroblasts Cementoblasts

Cellular-Acellular Cementum

Cementum
Varies in thickness

At apex (150-200 m) Thin cervically (10-15 m)

Firmly adherent with root dentine Highly responsive mineralized tissue: (maintenance of functional position of tooth)

Cementum
Calcified avascular mesenchymal tissue Major component: type I collagen (90%) ad type III (5%) Types: Acellular (primary) Cellular (secondary) Source: Extrinsic (Sharpeys fibers) Intrinsic (cementum matrix) Mixed

Acellular Cementum

First cementum formed

Before tooth reaches

occlusion Cervical 1/3rd - of root Sharpeys fibers

Acellular cementum
Fibers of Periodontal Ligament Epithelial Rests Cementum

Root dentine

Acellular cementum
Most common pattern- adjacent to dentine
Structureless Afibrillar cementum Covers cervical enamel

Cellular Cementum

Formed after tooth reaches occlusion More irregular Less calcified

Cellular cementum

Most common pattern

Apical area Inter-radicular areas Overlying acellular dentine

Cementocytes

Inactive In lacunae Processes present in canaliculi Processes connected via gap junctions

Cellular cementum

Cementum

Both types are arranged in lamellae separated by incremental lines (rest periods)

CEJ

Fail to meet

Edge-to-edge

Cementum overlaps enamel

Functions

Seal for the open dentinal tubules

Provides

attachment for the PDL

Physical Properties
Pale yellow
Softer than dentine Permeability:

Varies with age and type of cementum Decreases with age Cellular is more permeable More permeable than dentine

Cementicles
Calcified ovoid or round nodule found in the PDL
Single or multiple near

the cemental surface Free in ligament; attached or embedded in cementum Aging and at sites of trauma

Chemical Properties
By weight By volume

Inorganic 65% 45%

Organic 23% 33%

Water 12% 22%

Hydroxyapatite crystals similar to those in bone More concentration of trace elements (F) at surface F levels higher in acellular Collagenous organic matrix, primarily type I

Resorption & Repair of Cementum

Less susceptibility to resorption than bone Localized resorption areas occur Could be caused by microtrauma May continue to root dentine By multinucleated odontoclasts Reversal line

Alveolar Bone

Alveolar bone

Alveolar Bone

It is that portion of the maxilla and mandible that forms and supports the tooth socket (alveoli)

Alveolar Process
Alveolar bone proper Cribriform plate, Bundle bone and Lamina dura (radio)
Supporting bone Compact cortical plates Spongy or cancellous trabecular bone

Alveolar Bone
Forms with tooth eruption Tooth-dependent structure Consists of:

External plate of cortical bone Alveolar bone proper (inner socket wall) Cancellous bone

Alveolar Bone
Strucure - Cells:
Osteoblasts Osteocytes

Osteoclasts

(remodeling)

Composition:
2/3

inorganic 1/3 organic mainly type I collagen

Anatomical Subdivisions

Interdental / interproximal bone

Interradicular bone
Radicular bone

Anatomical Subdivisions

Alveolar Bone Remodeling

The coupled function of both osteoblasts and osteoclasts Essential for:
Normal function of teeth adaptation Repair Resistance of force Ca & P homeostasis (bone contains 90% of bodys Ca)

Complex process regulated by hormonal and local factors

Development of Bony Crypt

The alveolar process develops during the eruption of teeth

Development of Bony Crypt

Alveolar Process
No distinct boundary exists between the body of the maxilla or mandible (basal bone) and the alveolar process

If teeth are lost the alveolar bone disappears

A section through the mandible after removal of all teeth

Radiographic appearance of the lamina dura. The lamina dura is a radiopaque (white) line around the roots of the teeth and the alveolar crest.

Basal Bone

Fenestration & Dehiscence

Fenestration: Loss of radicular bone, NOT including marginal bone (window-like) Dehiscence: Loss of radicular bone, including marginal bone

Microscopic Features
Cortical bone is composed of osteons = Haversian systems

Bone Cells

Osteoblasts: Bone-forming cells Osteocytes Osteoclasts: Bone-resorbing cells